In the eyes of LeadingAge, an apt tagline for the home- and community-based services (HCBS) settings rule, also known as the Olmstead rule, might be “the road to hell is being paved with good intentions.”
The reason why is the rule, which means well in its desire to protect the civil rights of those in HCBS settings, unfortunately, unintentionally, is having the opposite effect, according to the organization. In a thoughtful white paper released Wednesday, LeadingAge details how the practice of the rule actually is limiting access to HCBS and forcing many older adults into institutional care settings.
The main problem with the directive? It doesn’t really apply to older people — particularly those with dementia who increasingly are making up a large portion of adult day and assisted living communities.
LeadingAge articulately lays out the misguided conditions of the current rule. Among these: The requirements to provide opportunities for employment, access to transportation, secured spaces through locked doors, and outings and field trips.
While all these aims sound reasonable, in reality, they don’t work well for adults who may have cognitive problems.
Consider these examples: Employment opportunities? For someone struggling to make sense of the every day holding a job might just cause more confusion and frustration. Public transportation sounds good, too, unless you have a problem wandering. Imagine how an HCBS provider must feel about giving someone with dementia a bus ticket. Locking rooms also sounds noble unless you have dementia and are paranoid. And regarding field trips, for those with dementia, as LeadingAge points out, just going to an adult day care building provides a significant enough of a change for that person.
There are other issues with the rule, such as the strain it places on an overstressed workforce. (In a perfect world, there would be several people ready to take people on outings. As it is, with this workforce shortage, an activity department might need some extra hands.)
So, yes, the Centers for Medicare & Medicaid Services would be wise to listen to LeadingAge, which is requesting a two-year moratorium to refine the rule. If CMS truly wants to offer opportunities for older adults, it will create a detour for the current Settings Rule road. When it tweaks the rule sufficiently, it might look more like a highway to heaven.
Liza Berger is editor of McKnight’s Home Care. Email her at [email protected].